Provider Demographics
NPI:1386711166
Name:HARTOG, JEFFREY MICHAEL (JEFFREY HARTOG MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:HARTOG
Suffix:
Gender:M
Credentials:JEFFREY HARTOG MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4355 BEAR GULLY RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-9422
Mailing Address - Country:US
Mailing Address - Phone:407-678-3116
Mailing Address - Fax:321-282-0565
Practice Address - Street 1:4355 BEAR GULLY RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-9422
Practice Address - Country:US
Practice Address - Phone:407-678-3116
Practice Address - Fax:321-282-0565
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64197208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery